A cross-sectional community-based study to assess ‘sleep hygiene’ in adults residing in Hubblli city

 

Manjunath S Nekar¹, Kanthesh K^2*, D D Bant³

 

Abstract               Background: Rapidly changing lifestyle preferences and practices among the urban population have the potential to cause chronic sleep deprivation, which accumulates and results in neurobehavioral and cognitive deficits. Sleep hygiene refers to the recommended behavioural and environmental practices that are intended to promote better quality sleep. Better sleep hygiene is believed to improve sleep quality. Objectives: To assess sleep hygiene practices among the adults residing in Hubballi city and to study the association of sleep hygiene practices with overall sleep quality and daytime sleepiness. Methodology: 400 adults residing in urban areas, Hubballi were assessed for their sleep hygiene practices and daytime sleepiness using Pittsburgh’s Sleep Quality Index (PSQI) and Epworth’s Sleepiness Scale (ESS). Chi-square test and ANOVA were used to test the association of the sleep hygiene practices with overall sleep quality and daytime sleepiness. Results: Among the participants, Males have better sleep quality and daytime awake fullness than females (p<0.05). Young adults have better sleep quality (mean 5.13±2.8) but are sleepier during the day (mean 7.92±3.5). Middle adults had better wakefulness (mean 6.7±3.7). People with higher SES had better sleep quality(p<0.05). Participants with poor sleep quality often resorted to smoking and increased consumption of caffeinated beverages to reduce their day time sleepiness. Reading novels or watching T.V was will help in reducing sleep latency and better sleep quality. Conclusion: Adoption of sleep hygiene practices should be promoted for maintenance of sleep /wake cycle. These are essential for maintenance of sleep quality and improvement of daytime efficiency.

Key Words: Sleep , Hygiene, PSQLI, ESS ,Behavioral, Lifestyle.

 

INTRODUCTION

Sleep is a recurring state of unconsciousness which is necessary for physical, mental, cognitive, emotional and intellectual well-being of an individual. Both physical and mental repair processes kick-in and accelerate during the hours of sleep. Historically, sleep was thought to be a passive state, that was initiated merely through ‘’withdrawal of sensory inputs’’. With advancement in the field of neurosciences, it has now been well-established, that withdrawal of sensory awareness is believed to be one of the many factors in sleep. In fact, an active initiation mechanism in the complicated neuronal network of the brain facilitates the relative and reversible sensory unresponsiveness and hence the initiation and maintenance of sleep ¹. The delicate mechanisms, which govern the regular sleep/wake cycle are prone to be affected by numerous physical, mental and environmental factors. Rapidly changing lifestyle preferences and practices among the urban population have the potential to cause chronic sleep deprivation, which accumulates and results in neurobehavioral and cognitive deficits.² Sleep deprivation has shown to cause an increase in feeling of sleepiness during daytime resulting in deterioration of individual work efficiency³. It has also been shown in scientific studies that sleep deprivation can result in altered mood, cognitive confusion with concomitant decrease in vigor and alertness.^4,5,6,7 Another real world risk associated with sleep deprivation is decreased driving ability and crash risk⁸. Sleep deprivation is also associated with numerous physiological consequences. Relatively short sleepers (< 7 hours) had increased risk of all-cause mortality⁹. There are also epidemiological evidences that reduced sleep duration is associated with larger Body Mass Index (BMI)¹⁰. Both short term sleep restriction and chronic sleep deprivation result in a number of abnormal physiological changes including high BP ¹¹, activation of sympathetic nervous system ¹², reduced leptin levels¹³ and increased inflammatory markers¹⁴. Better sleep hygiene is believed to improve sleep quality. Various sleep hygiene practices have been prescribed by clinicians as a part of non-pharmacological therapy for insomnia. However, no reliable studies have been conducted to substantiate the hypothesis that better sleep hygiene leads to better sleep quality. Therefore, this study was conducted in Hubballi city to assess the prevalence of sleep hygiene practices and to assess the association between these practices and overall sleep quality among the general population. The study will help us to highlight the role of various sleep hygiene practices in ensuring a better sleep quality In the wake of growing evidence associating sleep deprivation with numerous metabolic, endocrinological, cardiovascular, immunological and behavioral deteriorations, the necessity to improve sleep quality has been felt immensely. Sleep hygiene refers to the recommended behavioral and environmental practices that are intended to promote better quality sleep

Objective

To assess sleep hygiene practices among the adults residing in Hubballi city and to study the association of sleep hygiene practices with overall sleep quality and daytime sleepiness

 

MATERIALS AND METHODS

A cross-sectional, community based study to assess the sleep hygiene in adults residing in Hubballi city” was conducted from 19^th May, 2015 to 15^th June, 2015 at Karnataka Institute of Medical Sciences, Hubballi, Karnataka. Considering that the, prevalence of sleep hygiene practices among general population to be 50%, error margin to be 10% and confidence interval to be 95% the following formula has been used:

n = 4PQ/L²

 = 4(0.5) (0.5)/ (0.05)²

 = 400

Hence, the sample size was fixed at 400.

10 Areas of urban and sub-urban Hubballi were selected randomly. The participants of our study include adults aged 18-65 years residing in the above mentioned areas of Hubballi. The study population was divided into three categories viz, 18-25 year, 26-45 years and 46-65 years for convenience and analysis.A semi-structured, pre-validated questionnaire was developed and administered to adults aged 18-65 years. The questionnaire includes common sleep hygiene practices such as watching TV in bed, using mobile phones and computers until bedtime, smoking and consumption of alcohol or caffeinated beverages too closer to bed time, reading a novel in bed and so on. The questionnaire also contains sections developed using two highly reliable and validated scales viz, Pittsburgh’s Sleep Quality Index (PSQI) and Epworth’s Sleepiness scale (ESS). PSQI and ESS were included in the questionnaire to assess the association of sleep hygiene practices with sleep quality and day-time sleepiness.

 

Pittsburgh’s Sleep Quality Index (PSQI) ¹⁵

PSQI is a 19-item questionnaire designed to measure sleep quality over a 1-month period. The first 4 items ask the respondents about their usual bed time, wake time, sleep latency and sleep duration (fill-in-the-blank format). The remaining items ask if the respondents have, in the 1-month duration, experienced certain symptoms (scored from 0-3). The 19 primary items yield 7 different components (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, sleep medication and day-time dysfunction) and the global PSQI score. The PSQI global score has a good internal constancy. The individual components have agreeable internal constancy. PSQI has been extensively used in various studies to assess sleep quality in different age-groups and has demonstrated reliability and validity.

 

Epworth’s Sleepiness Scale (ESS) ¹⁶

ESS is a 7-item questionnaire which assesses daytime sleepiness. The 7 questions ask the respondents; how probable they were to fall asleep in certain circumstances during daytime. Each question is scored from 0 to 3 (0-never, 1-rarely, 2-occassionaly, 3-regularly) and the final ‘Sleep score’ is calculated as the sum of the 7 individual scores. ESS has a good internal constancy. ESS has been used as a tool to assess daytime sleepiness in various medially oriented studies and it has demonstrated excellent reliability and validity

 

 

 

 

 

RESULTS

In our study nearly nearly 164 (41%) of them were in the age group of 18-25 years, 146 (36.5%) between the age group of 26-45 years, 90 (22.5%) in the 46-65 years of age. Nearly 202 (50.5%) of the respondents were male and 198 (49.5%) were females. All the participants were literate in our study.

 

Table 1: Mean Values of Sleep hygiene variables